Advocacy

The ACP Advocate Blog

by Bob Doherty

Wednesday, January 25, 2012

Health Care Reform Barely Mentioned in SOTU???

Last night’s State of the Union address was many things, but one thing it wasn’t was a clarion call by the President for the public to support his health care reform law. Instead, he confined his comments to a pledge “not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men.”

You would think that the President would have spoken out more passionately on what he clearly considers to be his signature domestic accomplishment. Just as surprising, the Republican response by Governor Mitch Daniels (R-IN) didn’t even mention the party’s promise to repeal “ObamaCare.” His only implicit reference was in the context of distinguishing the GOP’s approach from his characterization of the President’s:

“In word and deed, the president and his allies tell us that we just cannot handle ourselves in this complex, perilous world without their benevolent protection. Left to ourselves, we might pick the wrong health insurance, the wrong mortgage, the wrong school for our kids; why, unless they stop us, we might pick the wrong light bulb.”

And that’s too bad. I would have liked to see President Obama make a clear case as to why the country is better off under the Affordable Care Act—and especially, I would have liked him to make the moral argument that it is simply wrong to deny millions of people access to health insurance simply because they can’t afford it, or work for an employer that doesn’t offer coverage, or live in an area where coverage is not accessible, or have a pre-existing health condition. I would have liked to have heard Governor Daniels explain what the GOP would offer instead of the ACA—and for that matter, whether the party even believes, as it has for almost its entire history, that a goal of public policy should be for everyone to have access to affordable health insurance coverage. After all, universal health insurance coverage was first proposed by a Republican president, Teddy Roosevelt, almost 100 years ago!

Just because the President and Governor Daniels didn’t have much to say about health care reform, though, doesn’t mean that there isn’t much to say. Tomorrow, ACP will be releasing its annual State of the Nation’s Health Care report. The report will provide an assessment of progress and challenges in U.S. health care, discuss the danger to health created by unwise budget cuts, offer an alternative framework to achieve hundreds of billions in savings by addressing the real cost drivers in health care, discuss the obstacles to achieving bipartisan common ground consensus created by the country's broken politics, and conclude with a challenge to the candidates, Republicans and Democrats alike, to provide clear answers about their plans for health care. (I will have more to say about ACP’s report in my next blog.) Last night, neither President Obama nor Governor Daniels were willing to reveal much, which is too bad, because voters have a right to know.

Today’s question: What did you think of health care reform getting only a passing reference in the President’s remarks and the GOP response?

Actually, the most recent Kaiser Family Foundation tracking poll finds that public attitudes about the health care law are more nuanced than the opposition that Arvind suggests. Although a higher percentage express an unfavorable opinion of the law (44%) than a favorable opinion (37%), a majority (50%) either want to expand the law or leave it in its current form, compared to the 40% who want to repeal it outright or replace it with a GOP-backed alternative. Pollsters have long known that some of the people who disapprove of the ACA do so because they believe that it doesn’t do enough to expand health care coverage! At the same time, most disapprove of the individual insurance mandate. So both supporters of the ACA and opponents of it can find elements of public opinion that they can point to as supporting their positions, but the public itself can best be described as divided and unsure—neither liking it in its entirety nor wanting to repeal it. Unfortunately, though, the politicians can’t move off of the polarizing fight over repeal.

I would like to think I am fairly representative of the public’s feelings on the ACA. One major problem is that politically both sides have painted themselves into a corner making any one in the middle disappear as they take positions on the extreme.

My concerns started with the process. Moderate Democrats and all Republicans were excluded from the process as a small group locked themselves into a room, came out with a product and then bragged “you will have to pass it to see what is in it.” This was combined with the delightful squeals of a leader stating they knew how to “whip’ their caucus members.

Here we are in the middle of an economic crisis remaking one sixth of the US economy and there is no debate, only the call for a VAT so as to be able to borrow more money, not pay down debt.

I have no idea if the good points in the bill were an accident or inserted as a selling point. Most people feel for those who are uninsured, unable to buy insurance, or in some other situation this bill addresses.

My concerns, like many others, are the large number of new boards, IRS agents, rules and regulations and taxes that this bill will produce magically after the next election cycle. We have already seen some of the new taxes put in place, and as noted by a number of comments, they will be passed on to the consumer in the form of higher prices.

What I know is that we have enough money in our system to provide medical care for everyone. Runaway profits in the drug/device, insurance, and hospital industry have enriched a few while leaving behind a public stressed trying to pay for a system they cannot comprehend nor have any reasonable recourse to change.

The ACP has shown any number of times and in a number of ways how we can reduce medical spending in the US. Taking these saving and applying it to those who are locked out of the current system would go a long way towards lowering debt while providing a more realistic system from which a patient can navigate.

The do more make more cycle has to be broken, along with the financial gaming of a broken system for personal enrichment.

Unfortunately both sides of Congress have taken positions in the opposite corners of the room and are receiving financial rewards for taking positions that will not allow for a reasonable discussion of this very important issue.

I would like to see the ACA repealed with much of the good immediately put back in place with a new law limited to those issues we, at least here, find acceptable. Keeping adult children on a family policy carries little cost due to the general good health of this group. Catastrophic coverage is often covered by Medicare or Medicaid, so those cost are already being covered by the system.

Tragically as we move away from these issues we enter a dark realm where money and power play the deciding role. Today I read that a drug company is going to reorganize the Australian medical system. IT companies have repeatedly failed to bring a product that can be used in a medical setting yet billions and billions of dollars are set aside and being spent with no real positive out come even being expected. People are being threatened with law suits over criticism of the DSM-V, and it is still a year away from publication

Those in the middle have been pushed aside. Polarization has reached a level that will not allow a public discourse. Political agendas have taken on a new meaning as everyone knows what is best for everyone else. No Keystone pipeline since ‘green” jobs are what this country needs.

I feel like I am part of a large group wondering the wilderness looking for that one group of honest politicians that will govern with wisdom and responsibility. I also feel that group is not going to be found.

Arvind, my comment is 100% correct. The KFF poll, as I noted above, shows most people disapprove of the individual mandate, yet 60 percent want to keep or expand the law and only 40 percent want to repel it or enact GOP alternative. Those are the facts, plain and simple. And constitutional law is not made by polls or public opinion. There has been times in US history where majorities of Americans favored policies that we now would view as unconstitutional and morally wrong, like segregation. I am not saying that the individual mandate is morally equivalent but I am suggesting that equating popularity with constitutionality is a flawed way of thinking about the constitution. I do believe that the unpopularity of the mandate is a concern, even if it is upheld by the Supreme Court, and it would be wise for supporters of the ACA to think about fallback alternatives to address the free rider problem that would have more public support . It is interesting though that in the one state with the mandate, MA, the law is overwhelming popular

EGMN
Notes From The Road
Bloggers post from medical meetings,
press conferences, and policy gatherings from the U.S. and around
the world, providing readers with a tasty analysis of the buzz,
the people, and the stories that don't get told.

FutureDocs Blog
A blog dedicated to medical education, news, and policy as well as career advising.